Our overall goal in this proposal is to test the hypothesis that (1) by promoting an agenda for preventive services and (2) by intervening through an interactive process of planned organizational change called continuous quality improvement(CQI), HMO's Blue Plus and HealthPartners can stimulate its contracted primary care clinics (PCCs) to develop an maintain office systems to routinely deliver the medical preventive services in the Health People 2000 goals. Furthermore, we intend to show that this intervention and improved process will have higher quality follow-up, that it will benefit equally the non-Blue Plus/HealthPartners patients of these clinics (especially those with low incomes), and that the secondary effects of the intervention on satisfaction and disease care will be beneficial. Finally, we shall measures the developmental and operating costs for the HMOs, clinics, and patients sand shall assess the potential for other clinics and other HMOs to adopt a similar program. Whether those aims can be accomplished will be tested through a randomized controlled trial in which the results of the HMO intervention in one set of typical PCCs (I) will be compared to a matched set of control PCCs (C). The specific services being promoted and tested are breast exams and mammograms in women 50 and over; pap smears in women 20 and over; tobacco cessation and hypertension and hypercholesterol identification/treatment in all adults; and influenza and hypercholesterol identification/treatment in all adults; and influenza and pneumococcal immunization in those 65 and over. The intervention will consist of training and consultation in an administrative process (CQI) and in demonstration of the value and approach to specific office systems that ensure that, as patients appear for normal office visits, they are screened and receive recommendations, assistance, and follow-up. The effects of this intervention will be measured by repeated post-visit patient surveys, chart audits, and assessment of clinic adoption of the program systems before, during, and after the intervention has been discontinued.